title: Aggressive coil embolization for connected aortopulmonary collateral arteries with large shunts developed after diaphragmatic plication performed after cavopulmonary connection to facilitate Fontan circulation.
abstract: We present two patients of univentricular physiology, who underwent diaphragmatic plication following the complication of diaphragmatic paralysis resulting from a bidirectional Glenn procedure. Over several months, complex connections developed between aortopulmonary collateral arteries, resulting in large shunts around the plication sites and an increased central pulmonary artery (PA) pressure to 14-15 mmHg. Most blood flow from these connections was reversed in the lower PAs of the affected side, reaching the contralateral lungs through the central PAs. Selective angiography identified almost all of the feeding arteries and complex connections. Aggressive coil embolization at these sites decreased the PA pressure to approximately 10 mmHg, enabling the Fontan procedure.
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Kitano
authors.forename: Satasho
authors.initials: S
authors.lastname: Yazaki
authors.forename: Koji
authors.initials: K
authors.lastname: Kagisaki
mesh_terms: D001011:Aorta / Q000503:physiopathology*; D001027:Aortography; D062186:Arterial Pressure; D003097:Collateral Circulation; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011652:Pulmonary Circulation; D012039:Regional Blood Flow; D012133:Respiratory Paralysis / Q000209:etiology / Q000601:surgery*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
keywords: diaphragmatic paralysis; selective angiography; univentricular physiology